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The hospice movement has shown that, even when underlying pathologies are incurable, there may be considerable scope for providing symptomatic relief through optimal use of pharmacological agents. Symptomatic palliative treatment has revolutionised terminal care, especially the management of severe pain. Could this principle equally be applied to the treatment of low-grade misery and everyday unhappiness?

Psychosis associated with stimulant use is an increasing problem, but there is little research evidence about the nature of the problem and its management.

Aims

To critically review the literature on stimulant psychosis and sensitisation.

Method

Systematic review of studies that have investigated stimulant use and psychosis in humans. The main outcome measures were increases in psychosis with stimulant use, and differences between stimulant users and non-users.

Results

Fifty-four studies met the inclusion criteria. Experimental studies show that a single dose of a stimulant drug can produce a brief increase in psychosis ratings (a ‘response’) in 50–70% of participants with schizophrenia and preexisting acute psychotic symptoms, unaffected by the presence of antipsychotic medication. Those with schizophrenia who do not have acute psychotic symptoms respond, but less frequently (30%). There has been little research into the longer-term effects of use.

Conclusions

Compliance with antipsychotic medication by someone with schizophrenia will not prevent a relapse or worsening of psychotic symptoms if stimulants are used. Low-dose antipsychotic treatment may be beneficial in stimulant users, to prevent sensitisation.

A number of functional brain abnormalities have been reported in schizophrenia, but it remains to be determined which of them represent trait and state markers of the illness.

Aims

To delineate regional brain dysfunctions that remain stable and those that fluctuate during the course of schizophrenia.

Method

A cohort of patients with first-episode schizophrenia and a matched group of control participants underwent functional magnetic resonance imaging on two occasions 6–8 weeks apart during performance of a working memory task. The patients' disease was in partial remission at the second scan.

Results

Relative to control participants, the function of the left dorsolateral prefrontal cortex, left thalamus and right cerebellum remained disturbed in the people with schizophrenia, whereas the dysfunction of the right dorsolateral prefrontal cortex, right thalamus, left cerebellum and cingulate gyrus normalised, with significant reduction in symptoms.

Conclusions

These results suggest that dysfunction of the left fronto-thalamo-cerebellar circuitry is a relatively stable characteristic of schizophrenia, whereas disturbance of the right circuitry and cingulate gyrus is predominantly a state-related phenomenon.

Impairments in cognitive functioning are common in schizophrenia, and the degree of impairment may be associated with the individual's age at onset of the disorder.

Aims

To examine the effect of age at onset on cognitive functioning using the California Verbal Learning Test, sub-tests from the Wechsler Memory Scale – Revised and sub-scales from the Wechsler Adult Intelligence Scale – Revised among families with schizophrenia.

Method

The effect of age at onset on cognitive function in 237 people with schizophrenia from a population-based sample was examined using linear mixed effects models with family as the random effect, and age, gender, chronicity of the illness and number of affected first-degree relatives as fixed effects.

Results

Impairment in verbal learning and memory was associated with earlier disease onset. No association was found for working memory or IQ.

Conclusions

In patients with early-onset schizophrenia, verbal memory functions in particular should be taken into account in neuropsychological evaluation and efforts at remediation.

Adverse early circumstances may be more common in people who later develop psychotic disorders.

Aims

To use data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences.

Method

Psychiatric disorders were identified through structured assessment of adults resident in private households in Britain (n=8580). Respondents were asked whether they had experienced selected events displayed on cards.

Results

Compared with respondents with other psychiatric disorders or with none, the prevalence of every experience bar one was significantly elevated in those with definite or probable psychosis. The largest odds ratio was for sexual abuse. Controlling for depressed mood somewhat reduced the odds ratios for the individual experiences.

Conclusions

In people with psychosis, there is a marked excess of victimising experiences, many of which will have occurred during childhood. This is suggestive of a social contribution to aetiology.

Associations have been demonstrated between contextual (area level) factors and a range of physical health outcomes, but their relationship with mental health outcomes is less well understood.

Aims

To investigate the relative strength of association between individual and area-level demographic and socioeconomic factors and mood disorder prevalence in the UK.

Method

Cross-sectional data from 19 687 participants from the European Prospective Investigation into Cancer and Nutrition in Norfolk.

Results

Area deprivation was associated with current (12-month) mood disorders after adjusting for individual-level socio-economic status (OR for top v. bottom quartile of deprivation scores 1.29, 95% C11.1–1.5, P < 0.001). However, this association was small relative to those observed for individual marital and employment status. Significant residual area-level variation in current mood disorders (representing 3.6% of total variation, P=0.04) was largely accounted for by individual-level factors.

Conclusions

The magnitude of the association between socio-economic status and mood disorders is greater at the individual level than at the area level.

In adults the prevalence of psychological distress varies in different ethnic groups, and this has been explained by differences in socio-economic status. Is this also the case in adolescents?

Aims

To examine whether ethnic differences in prevalence of psychological distress in adolescents are associated with social deprivation.

Method

A cross-sectional questionnaire survey was used to assess 2790 male and female pupils, aged 11–14 years, from a representative sample of 28 east London secondary schools.

Results

Rates of psychological distress were similar to rates in UK national samples in boys and girls. Bangladeshi pupils, although highly socially disadvantaged, had a lower risk of psychological distress (OR=0.63, 95% CI 0.4–0.9). Non-UK White girls had higher rates of depressive symptoms (OR=1.54, 95% C11.1–2.2).

Conclusions

High rates of depressive symptoms in non-UK White girls may be related to recent migration. Low rates of psychological distress in Bangladeshi pupils in this sample relative to White pupils, despite socio-economic disadvantage, could be associated with cultural protective factors that require further investigation.

Doctors are less likely to diagnose depression in men than in women. Little research has been conducted to explore the underlying reasons for this in rural settings, or to compare primary care doctors' and male patients' ratings of perceived depression.

Aims

To identify symptomatic and socio-demographic correlates of depression in men attending a rural practice, and to compare and contrast general practitioners' and patients' assessments of depression.

Method

All male patients of working age attending a rural general practice over a 12-month period were invited to participate.

Results

Men reporting recent’ chest pain’ or ‘feeling tired/little energy’, expressing low job enjoyment or with a previous diagnosis of depression were more likely to be scored above threshold on the Hospital Anxiety and Depression Scale – Depression sub-scale. There was little agreement between the doctors and their male patients about the degree of perceived depression.

Conclusions

Educational interventions aimed at addressing the diagnosis of depression in men should take greater account of factors within a particular social setting.

Knowledge of when and how to implement treatments to prevent criminal offending among people with schizophrenia is urgently needed.

Aims

To identify opportunities for interventions to prevent offending among men with schizophrenic disorders by tracking their histories of offending and admissions to hospital.

Method

We examined 232 men with schizophrenic disorders discharged from forensic and general psychiatric hospitals. Data were collected from participants, family members and official records.

Results

More than three-quarters (77.8%) of the forensic patients had previously been admitted to general psychiatric services; 24.3% of the general psychiatric patients had a criminal record. Offences had been committed by 39.8% of the forensic patients and 10.8% of the general psychiatric patients before their first admission to general psychiatry, and after their first admission these 59 patients committed 195 non-violent and 59 violent offences. Subsequently, 49 of them committed serious violent offences that led to forensic hospital admission. The offenders were distinguished by a pervasive and stable pattern of antisocial behaviour evident from at least mid-adolescence.

Conclusions

General psychiatry requires resources in order to prevent criminal offending among a subgroup of patients with schizophrenic disorders.

The role of journals in disseminating research to clinicians is increasingly debated. Current measures of esteem for journals (e.g. impact factors) may not indicate clinical penetration.

Aims

To assess the perceived importance of different mental health journals to psychiatrists' clinical practice and compare this with impact factors.

Method

Random samples of psychiatrists providing child and adolescent, adults of working age and old age services chose up to ten journals read or consulted with regard to their clinical work, ranking the top three. For these journals, comparisons were made with impact factors and importance as outlets for UK psychiatry research.

Results

A total of 560 questionnaires were completed (47%). Two membership journals (the British Journal of Psychiatry and the BMJ) were most read and highest ranked. Associations between impact factors, clinicians' ratings and importance as outlets for psychiatry papers varied.

Conclusions

The results could lead to reconsideration of the importance of some journals. Academic assessments of the status of journals should not be assumed to reflect their influence on clinicians.

There is evidence that the superior temporal gyrus and Heschl's gyrus within it are implicated in schizophrenia. We investigated neuronal and glial cell density and cortical thickness within Heschl's gyrus, using the optical disector to estimate cell density within cortical layers 3 and 5 in tissue derived postmortem from people with diagnoses of major depressive disorder, schizophrenia and bipolar disorder, compared with normal controls (n=15 per group). No significant difference in neuronal or glial cell density or in cortical thickness was observed between the groups; our findings therefore provide no support for the presence of cellular pathology within Heschl's gyrus in schizophrenia.